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<br /> - 33Þ <br /> Mailing address: -NA- <br /> Phone: <-) <br /> <br /> 5. List the number of tanks, the size, and the contents of each tank at the facility for which reimbursement is being sought <br /> in this application. If the tanks were removed and/or abandoned note which ones were removed and/or abandoned and <br /> the date(s) they were removed from service: <br /> Tank No. Capacity (gallons) Contents (gasoline, diesel. etc.) Removed and/or Date Removed <br />i Abandoned from Service <br /> (indicatc which) <br /> 1 3000 1/91 3/89 <br /> Diesel <br />) 2 <br /> 3000 - Diesel 1 / Q 1 3/89 <br />\ 3 10,000 1/91 3/Rg <br /> G",c::nl;np <br /> 4 10,000 Gasoline 1/91 <br /> 3/89 <br />\ 5 <br />I 6 i <br /> 7 <br />I 8 <br />I- 9 <br /> I 10 <br />I 11 <br />I 12 <br /> <br />I 6. @/NO Have the tanks from which the release occurred been registered with the TNRCC? If yes, <br /> provide the facility registration number assigned by the TNRCC: #21680 <br />I If no, please note that all tanks that are subjed to the registration requirements must be <br /> registered and tank registration fees paid before the reimbursement check can be released. <br /> 7. §NO Have the tank owner(s) and/or operator(s) registered with the TNRCC all other tank systems in <br />I Texas which they knowingly own or operate? <br /> 8. @/NO Have the tank owner(s) and/or operator(s) paid in full all annual tank registration fees due since <br />I September 1, 1987 for all tanks which they own or operate? IT no, please note that all <br /> outstanding fees must be paid in full before the reimbursement check can be released. <br />I I <br /> TNRCC APPLICATION FOR REIMBURSEMENT E-Z FORM 5 <br /> ----- -~~^ ~ "t'" 01' <br />